Amended  IN  Senate  March 19, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill No. 156

Introduced by Senator Nielsen
(Principal coauthor: Assembly Member Gallagher)

January 23, 2019

An act to amend Section 128200 1250.8 of the Health and Safety Code, relating to healthcare. health facilities.


LEGISLATIVE COUNSEL'S DIGEST


SB 156, as amended, Nielsen. Healthcare: workforce training programs. Health facilities: consolidated licensing.
Under existing law, the California Emergency Services Act, the Governor is authorized to proclaim a state of emergency, as defined, under specified circumstances. The California Emergency Services Act also authorizes the governing body of a city, county, city and county, or an official designated by ordinance adopted by that governing body, to proclaim a local emergency, as defined.
Existing law requires the State Department of Public Health to license and regulate general acute care hospitals. Existing law generally requires the department to issue a single consolidated license to a general acute care hospital that meets the requirements for licensure and includes more than one physical plant maintained and operated on separate premises located within a 15-mile radius of each other, and requires the single consolidated license to be renewed annually. Existing law authorizes the director to exempt an applicant from the 15-mile radius requirement under specified circumstances, including that one or more of the physical plants is located in a rural area.
This bill would require the director to issue a single consolidated license to a general acute care hospital or acute psychiatric hospital that does not meet the 15-mile radius requirement if it is located in a city, county, or city and county that is in an area affected by a proclaimed state of emergency or local emergency, and otherwise satisfies specified requirements, including that it can provide adequate administrative and professional supervision. The bill would require this single consolidated license to expire 2 years from the date of its issuance, and would authorize the license to be renewed every 2 years for a period not to exceed 6 years from the initial date of issuance.

Existing law, the Song-Brown Health Care Workforce Training Act, declares the intent of the Legislature to increase the number of students and residents receiving quality education and training in specified primary care specialties and as primary care physician’s assistants, primary care nurse practitioners, and registered nurses.

This bill would make technical, nonsubstantive changes to those provisions.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 Section 1250.8 of the Health and Safety Code is amended to read:

1250.8.
 (a) Notwithstanding subdivision (a) of Section 127170, the department, upon application of a general acute care hospital that meets all the criteria of subdivision (b), and other applicable requirements of licensure, shall issue a single consolidated license to a general acute care hospital that includes more than one physical plant maintained and operated on separate premises or that has multiple licenses for a single health facility on the same premises. A single consolidated license shall not be issued where if the separate freestanding physical plant is a skilled nursing facility or an intermediate care facility, whether or not the location of the skilled nursing facility or intermediate care facility is contiguous to the general acute care hospital unless the hospital is exempt from the requirements of subdivision (b) of Section 1254, or the facility is part of the physical structure licensed to provide acute care.
(b) The issuance of a single consolidated license shall be based on satisfy the following criteria:
(1) There is a single governing body for all the facilities maintained and operated by the licensee.
(2) There is a single administration for all the facilities maintained and operated by the licensee.
(3) There is a single medical staff for all the facilities maintained and operated by the licensee, with a single set of bylaws, rules, and regulations, which prescribe a single committee structure.
(4) Except as provided otherwise in this paragraph, paragraph and paragraph (5), the physical plants maintained and operated by the licensee which that are to be covered by the single consolidated license are shall be located not more than 15 miles apart. within a 15-mile radius of each other. If an applicant provides evidence satisfactory to the department that it can comply with all requirements of licensure and provide quality care and adequate administrative and professional supervision, the director may issue a single consolidated license to a general acute care hospital that operates two or more physical plants located more than 15 miles apart under any of the following circumstances:
(A) One or more of the physical plants is located in a rural area, as defined by regulations of promulgated by the director.
(B) One or more of the physical plants provides only outpatient services, as defined by the department.
(C) If Section 14105.986 of the Welfare and Institutions Code is implemented and the applicant meets all of the following criteria:
(i) The applicant is a nonprofit corporation.
(ii) The applicant is a children’s hospital listed in Section 10727 of the Welfare and Institutions Code.
(iii) The applicant is affiliated with a major university medical school and located adjacent thereto.
(iv) The applicant operates a regional tertiary care facility.
(v) One of the physical plants is located in a county that has a consolidated and county government structure.
(vi) One of the physical plants is located in a county having a population between 1,000,000 and 2,000,000.
(vii) The applicant is located in a city with a population between 50,000 and 100,000.
(5) (A) If an applicant provides evidence satisfactory to the department that it can comply with all requirements of licensure and provide quality care and adequate administrative and professional supervision, the director shall issue a single consolidated license to a general acute care hospital that operates two or more physical plants located more than 15 miles apart under the following circumstance:
The applicant is located in a city, county, or city and county that is in an area affected by a proclaimed state of emergency or local emergency, as defined in subdivisions (b) and (c) of Section 8558 of the Government Code and, as a result of the emergency, the applicant has an insufficient number of licensed beds for a prolonged period of time, which necessitates the issuance of a single consolidated license to ensure continuity in the provision of emergency services and care, as defined in Section 1317.1.
(B) For purposes of subparagraph (A), “applicant” means a general acute care hospital, as defined in subdivision (a) of Section 1250, or acute psychiatric hospital, as defined in subdivision (b) of Section 1250.
(C) Notwithstanding subdivision (c), for purposes of this paragraph, a single consolidated license shall expire two years from the date of its issuance, and may be renewed every two years for a period not to exceed six years from the initial date of issuance.
(c) In issuing the single consolidated license, the state department shall specify the location of each supplemental service and the location of the number and category of beds provided by the licensee. The Except as provided in subparagraph (C) of paragraph (5) of subdivision (b), the single consolidated license shall be renewed annually.
(d) To the extent required by Chapter 1 (commencing with Section127125) Section 127125) of Part 2 of Division 107, a general acute care hospital that has been issued a single consolidated license: license shall not do any of the following:
(1) Shall not transfer Transfer from one facility to another a special service described in Section 1255 without first obtaining a certificate of need.
(2) Shall not transfer, Transfer, in whole or in part, from one facility to another, a supplemental service, as defined in regulations of the director pursuant to this chapter, without first obtaining a certificate of need, unless the licensee, 30 days prior to the relocation, notifies the Office of Statewide Health Planning and Development, the applicable health systems agency, and the state department of the licensee’s intent to relocate the supplemental service, and includes with this notice a cost estimate, certified by a person qualified by experience or training to render the estimates, which estimates that the cost of the transfer will not exceed the capital expenditure threshold established by the Office of Statewide Health Planning and Development pursuant to Section 127170.
(3) Shall not transfer Transfer beds from one facility to another facility, without first obtaining a certificate of need unless, 30 days prior to the relocation, the licensee notifies the Office of Statewide Health Planning and Development, the applicable health systems agency, and the state department of the licensee’s intent to relocate health facility beds, and includes with this notice both of the following:
(A) A cost estimate, certified by a person qualified by experience or training to render the estimates, which estimates that the cost of the relocation will not exceed the capital expenditure threshold established by the Office of Statewide Health Planning and Development pursuant to Section 127170.
(B) The identification of the number, classification, and location of the health facility beds in the transferor facility and the proposed number, classification, and location of the health facility beds in the transferee facility.
Except as otherwise permitted in Chapter 1 (commencing with Section 127125) of Part 2 of Division 107, or as authorized in an approved certificate of need pursuant to that chapter, health facility beds transferred pursuant to this section shall be used in the transferee facility in the same bed classification as defined in Section 1250.1, as the beds were classified in the transferor facility.
Health facility beds transferred pursuant to this section shall not be transferred back to the transferor facility for two years from the date of the transfer, regardless of cost, without first obtaining a certificate of need pursuant to Chapter 1 (commencing with Section 127125) of Part 2 of Division 107.
(e) Transfers pursuant to subdivision (d) shall satisfy all applicable requirements of licensure and shall be subject to the written approval, if required, of the state department. The state department may adopt regulations that are necessary to implement this section. These regulations may include a requirement that each facility of a health facility that is subject to a single consolidated license have an onsite full-time or part-time administrator.
(f) As used in this section, “facility” means a physical plant operated or maintained by a health facility subject to a single, consolidated license issued pursuant to this section.
(g) For purposes of selective provider contracts negotiated under the Medi-Cal program, the treatment of a health facility with a single consolidated license issued pursuant to this section shall be subject to negotiation between the health facility and the California Medical Assistance Commission. A general acute care hospital that is issued a single consolidated license pursuant to this section may, at its option, be enrolled in the Medi-Cal program as a single business address or as separate business addresses for one or more of the facilities subject to the single consolidated license. Irrespective of whether the general acute care hospital is enrolled at one or more business addresses, the department may require the hospital to file separate cost reports for each facility pursuant to Section 14170 of the Welfare and Institutions Code.
(h) For purposes of the Annual Report of Hospitals Hospitals, which is required by regulations adopted by the state department pursuant to this part, the state department and the Office of Statewide Health Planning and Development may require reporting of bed and service utilization data separately by each facility of a general acute care hospital issued a single consolidated license pursuant to this section.
(i) The amendments made to this section during the 1985–86 Regular Session of the Legislature pertaining to the issuance of a single consolidated license to a general acute care hospital in the case where the separate physical plant is a skilled nursing facility or intermediate care facility shall not apply to the following facilities:
(1) A facility that obtained a certificate of need after August 1, 1984, and prior to February 14, 1985, as described in this subdivision. The certificate of need shall be for the construction of a skilled nursing facility or intermediate care facility that is the same facility for which the hospital applies for a single consolidated license, pursuant to subdivision (a).
(2) A facility for which a single consolidated license has been issued pursuant to subdivision (a), as described in this subdivision, prior to the effective date of the amendments made to this section during the 1985–86 Regular Session of the Legislature.
A facility that has been issued a single consolidated license pursuant to subdivision (a), as described in this subdivision, shall be granted renewal licenses based upon the same criteria used for the initial consolidated license.
(j) If the state department issues a single consolidated license pursuant to this section, the state department may take any action authorized by this chapter, including, but not limited to, any action specified in Article 5 (commencing with Section 1294), with respect to a facility, or a service provided in a facility, that is included in the consolidated license.
(k) The eligibility for participation in the Medi-Cal program (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code) of a facility that is included in a consolidated license issued pursuant to this section, provides outpatient services, and is located more than 15 miles from the health facility issued the consolidated license shall be subject to a determination of eligibility by the state department. This subdivision shall not apply to a facility that is located in a rural area and is included in a consolidated license issued pursuant to subparagraphs (A), (B), and (C) of paragraph (4) of subdivision (b). Regardless of whether a facility has received or not received a determination of eligibility pursuant to this subdivision, this subdivision shall not affect the ability of a licensed professional, providing services covered by the Medi-Cal program to a person eligible for Medi-Cal in a facility subject to a determination of eligibility pursuant to this subdivision, to bill the Medi-Cal program for those services provided in accordance with applicable regulations.
(l) Notwithstanding any other provision of law, the director may issue a single consolidated license for a general acute care hospital to Children’s Hospital Oakland and San Ramon Regional Medical Center.
(m) Notwithstanding any other provision of law, the director may issue a single consolidated license for a general acute care hospital to Children’s Hospital Oakland and the John Muir Medical Center, Concord Campus.
(n) (1) To the extent permitted by federal law, payments made to Children’s Hospital Oakland pursuant to Section 14166.11 of the Welfare and Institutions Code shall be adjusted as follows:
(A) The number of Medi-Cal payment days and net revenues calculated for the John Muir Medical Center, Concord Campus under the consolidated license shall not be used for eligibility purposes for the private hospital disproportionate share hospital replacement funds for Children’s Hospital Oakland.
(B) The number of Medi-Cal payment days calculated for hospital beds located at John Muir Medical Center, Concord Campus that are included in the consolidated license beginning in the 2007–08 fiscal year shall only be used for purposes of calculating disproportionate share hospital payments authorized under Section 14166.11 of the Welfare and Institutions Code at Children’s Hospital Oakland to the extent that the inclusion of those days does not exceed the total Medi-Cal payment days used to calculate Children’s Hospital Oakland payments for the 2006–07 fiscal year disproportionate share replacement.
(2) This subdivision shall become inoperative in the event that the two facilities covered under the consolidated license described in subdivision (a) are located within a 15-mile radius of each other.

SECTION 1.Section 128200 of the Health and Safety Code is amended to read:
128200.

(a)This article shall be known, and may be cited, as the Song-Brown Health Care Workforce Training Act.

(b)(1) The Legislature hereby finds and declares that physicians engaged in family medicine are in very short supply in California. The current emphasis placed on specialization in medical education has resulted in a shortage of physicians trained to provide comprehensive primary healthcare to families. The Legislature hereby declares that it regards the furtherance of a greater supply of competent family physicians to be a public purpose of great importance and further declares the establishment of the program pursuant to this article to be a desirable, necessary, and economical method of increasing the number of family physicians to provide needed medical services to the people of California. The Legislature further declares that it is to the benefit of the state to assist in increasing the number of competent family physicians graduated by colleges and universities of this state to provide primary healthcare services to families within the state.

(2)The Legislature finds that the shortage of family physicians can be improved by the placing of a higher priority by public and private medical schools, hospitals, and other healthcare delivery systems in this state, on the recruitment and improved training of medical students and residents to meet the need for family physicians. To help accomplish this goal, each medical school in the state is encouraged to organize a strong family medicine program or department. It is the intent of the Legislature that the programs or departments be headed by a physician who possesses specialty certification in the field of family medicine, and has broad clinical experience in the field of family medicine.

(3)The Legislature further finds that encouraging the training of primary care physician’s assistants and primary care nurse practitioners will assist in making primary healthcare services more accessible to the residents and will, in conjunction with the training of family physicians, lead to an improved healthcare delivery system in the state.

(4)Community hospitals in general and rural community hospitals in particular, as well as other healthcare delivery systems, are encouraged to develop family medicine residencies in affiliation or association with accredited medical schools, to help meet the need for family physicians in geographical areas of the state with recognized family primary healthcare needs. Utilization of expanded resources beyond university-based teaching hospitals should be emphasized, including facilities in rural areas wherever possible.

(5)The Legislature also finds and declares that nurses are in very short supply in the state. The Legislature hereby declares that it regards the furtherance of a greater supply of nurses to be a public purpose of great importance and further declares the expansion of the program pursuant to this article to include nurses to be a desirable, necessary, and economical method of increasing the number of nurses to provide needed nursing services to the people of California.

(6)It is the intent of the Legislature to provide for a program designed primarily to increase the number of students and residents receiving quality education and training in the primary care specialties of family medicine, internal medicine, obstetrics and gynecology, and pediatrics and as primary care physician’s assistants, primary care nurse practitioners, and registered nurses and to maximize the delivery of primary care family physician services to specific areas of California where there is a recognized unmet priority need. This program is intended to be implemented through contracts with accredited medical schools, teaching health centers, programs that train primary care physician’s assistants, programs that train primary care nurse practitioners, programs that train registered nurses, hospitals, and other healthcare delivery systems based on per-student or per-resident capitation formulas. It is further intended by the Legislature that the programs will be professionally and administratively accountable so that the maximum cost-effectiveness will be achieved in meeting the professional training standards and criteria set forth in this article and Article 2 (commencing with Section 128250).